Provider Demographics
NPI:1568825750
Name:SAMUEL G SOLIVEN DDS INC
Entity Type:Organization
Organization Name:SAMUEL G SOLIVEN DDS INC
Other - Org Name:UNIVERSAL DENTAL SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:GONZALES
Authorized Official - Last Name:SOLIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-794-2294
Mailing Address - Street 1:1835 EL CAJON BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2591
Mailing Address - Country:US
Mailing Address - Phone:619-794-2294
Mailing Address - Fax:619-269-4249
Practice Address - Street 1:1835 EL CAJON BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2591
Practice Address - Country:US
Practice Address - Phone:619-794-2294
Practice Address - Fax:619-269-4249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty